Acuerdo de Asociación Transpacífico (TPP): una visión desde Colombia

The Colombian Foreign Policy towards the Pacific Rim has focused its attention on participation in the region's economic cooperation system. From the end of the 1980s to the present, there have been different results that have influenced the international insertion strategies of the country. Specifically, the Trans-Pacific Partnership Agreement (TPP) is one of the main scenarios for economic and political dialogue with the countries of East Asia and Oceania. In the process of building this public policy, state and non-state actors have the accumulated experience to carry out the proposed guidelines for this region of the planet. The articulation of a systematic agenda of international insertion that allows weighting all the challenges offered by the TPP in a region with high degrees of political-economic interdependence within the international system of the early 21st century is essential.La Política Exterior Colombiana hacia la Cuenca del Pacífico ha centrado su atención en la participación en el sistema de cooperación económica de la región. Desde finales de la década de 1980 hasta la actualidad, se han producido diferentes resultados que han incidido en las estrategias de inserción internacional del país. Concretamente, el Acuerdo de Asociación Transpacífico (TPP) se constituye en uno de los principales escenarios para el diálogo económico y político con los países de Asia Oriental y Oceanía. En el proceso de construcción de esta política pública, los actores estatales y no-estatales cuentan con la experiencia acumulada para llevar a cabo las directrices propuestas para esta región del planeta. Es fundamental la articulación de una agenda sistemática de inserción internacional que permita ponderar todos los desafíos que ofrece el TPP en una región con altos grados de interdependencia político-económica dentro del sistema internacional de comienzos del siglo XXI

Acuerdo de Asociación Transpacífico (TPP): una visión desde Colmbia

La Política Exterior Colombiana hacia la Cuenca del Pacífico ha centrado su atención en la participación en el sistema de cooperación económica de la región. Desde finales de la década de 1980 hasta la actualidad, se han producido diferentes resultados que han incidido en las estrategias de inserción internacional del país. Concretamente, el Acuerdo de Asociación Transpacífico (TPP) se constituye en uno de los principales escenarios para el diálogo económico y político con los países de Asia Oriental y Oceanía. En el proceso de construcción de esta política pública, los actores estatales y no-estatales cuentan con la experiencia acumulada para llevar a cabo las directrices propuestas para esta región del planeta. Es fundamental la articulación de una agenda sistemática de inserción internacional que permita ponderar todos los desafíos que ofrece el TPP en una región con altos grados de interdependencia político-económica dentro del sistema internacional de comienzos del siglo XXI

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Foro de cooperación económica Asia-Pacífico – APEC Japón 2010: ¿fin de la moratoria para Colombia?*

El Foro de Cooperación Económica Asia-Pacífico (APEC) se reunirá durante el año 2010 en las principales ciudades de Japón, para definir su futuro como organización internacional intergubernamental. En este sentido, tratará de abordar el levantamiento de la moratoria impuesta para el ingreso de nuevas economías como Colombia a APEC. Para ello, la construcción de la política exterior colombiana hacia la Cuenca del Pacífico será fundamental en aras del fortalecimiento de las relaciones diplomáticas, comerciales y culturales con esta región del planeta. Palabras clave: Asia-Pacífico, APEC Japón 2010, Colombia, Moratoria, Integración Económica Regional